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1.
Rev. argent. radiol ; 85(1): 3-10, ene. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1155707

ABSTRACT

Resumen Objetivo: Analizar características por resonancia magnética (RM) de gliomas IDH-mutados (grado II y III) en base a parámetros cualitativos, a fin de valorar el rendimiento del signo del mismatch T2-FLAIR y otras características morfológicas de los tumores, en predecir el estado del 1p/19q y su reproducibilidad interobservador. Métodos Estudio retrospectivo, descriptivo y analítico sobre una cohorte de 53 gliomas IDH-mutados (grado II y III) y molecularmente definidos respecto al 1p/19q, seleccionados a partir de la base de datos de la institución, durante el periodo 2014- 2019. Dos neuroradiólogos evaluaron características imagenológicas de forma independiente y enmascarada al diagnóstico: mismatch T2-FLAIR, localización tumoral, bordes, señal, infiltración cortical e inhomogeneidad en T2. Los casos discordantes fueron evaluados por un tercer neuroradiólogo de mayor experiencia. Resultados: Treinta de 53 (56,6%) gliomas fueron no codelecionados, y 23/53 (43,4%) codelecionados. El signo del mismatch T2-FLAIR fue positivo en 16/53 (30,18%) pacientes, 15/16 (93,75%) no codelecionados y 1/16 (6,25%) codelecionado (Exacto de Fisher p = <,0001). Los dos evaluadores demostraron una concordancia interobservador casi perfecta para ese signo, κ =,907 (95% CI, 0,781 a 1,0). La especificidad y el valor predictivo positivo del signo para predecir la ausencia de la codeleción fue de un 95,7% y un 93,8% respectivamente. Discusión: La reciente actualización en la clasificación de los gliomas los clasifica acorde a su perfil molecular. En los últimos años, varios investigadores han estudiado características morfológicas por RM de los tumores con la intención de predecir las características moleculares de los mismos. Conclusión: En nuestra población, el signo del mismatch T2-FLAIR es el único biomarcador radiológico que muestra asociación estadísticamente significativa en predecir la ausencia de codeleción en los gliomas IDH-mutados (grado II y III), con una alta especificidad y un alto valor predictivo positivo.


Abstract Objective: To analyze magnetic resonance (MR) characteristics of IDH-mutated gliomas (grades II/III) utilizing qualitative parameters with the goal of assessing the performance of the T2-FLAIR mismatch sign and other morphological characteristics of tumors in predicting the 1p/19q co-deletion status as well as inter-observer reproducibility. Methods: Retrospective and descriptive study analyzing a cohort of 53 IDH-mutated lower-grade (grades II/III) gliomas with known 1p/19q co-deletion status. Patients meeting selection criteria for this study were taken from our institutional data from 2014-2019. Two neuroradiologists assessed the following imaging characteristics independently, and blinded from the diagnosis: T2-FLAIR mismatch, tumor location, borders, signal characteristics, cortical infiltration and T2* inhomogeneity. In the event of discordant interpretations, a third senior neuroradiologist also evaluated the case. Results: 23 of the 53 (43.4%) gliomas demonstrated 1p/19q co-deletion and 30 of 53 (56.6%) did not. T2-FLAIR mismatch was positive in 16 of 53 cases (30.2%) with 15 of 16 (93.8%) demonstrating no co-deletion and 1/16 (6.25%) with co-deletion (Fisher's exact p = < .0001). The two readers showed an almost perfect interreader agreement for this sign κ = 0.907 (95% CI, 0.781 to 1.0). Specificity and positive predictive value of the sign to predict the absence of co-deletion was 95.7% and 93.8% respectively. Discussion: The recent update in classification of lower-grade gliomas segregates gliomas according to molecular profile. In the recent past, many researchers have studied MR morphologic characteristics of these tumors with the intention of predicting molecular features of said tumors Conclusion: In our patient population, T2-FLAIR mismatch sign is the only radiologic biomarker that shows statistically significant association with the absence of 1p/19q co-deletion in lower-grade gliomas, with high specificity and positive predictive value.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Brain Neoplasms/diagnostic imaging , Biomarkers , Glioma/diagnostic imaging , Oligodendroglioma/diagnostic imaging , Astrocytoma/diagnostic imaging , Magnetic Resonance Spectroscopy , Epidemiology, Descriptive , Retrospective Studies , Glioma/classification
2.
Rev. argent. radiol ; 85(1): 11-20, ene. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1155708

ABSTRACT

Resumen La presencia de lesiones quísticas de etiología oncológica en el encéfalo es cada vez más frecuente. El rol del especialista en imágenes es describir sus características, morfología y comportamiento con el contraste endovenoso, para llegar a realizar un diagnóstico presuntivo y enumerar sus diagnósticos diferenciales, y así orientar al médico tratante. Haremos una revisión de las lesiones quísticas de etiología oncológica de presentación frecuente en el encéfalo.


Abstract The presence of an oncologic cystic formation in the brain is frequent. The imaging specialist's role is to describe its features, morphology, and image enhancement characteristics with endovenous contrast, to make a presumptive diagnosis, and enumerated differential diagnoses and thus orientate the practitioner. We will analyze the most common expansive cystic formations.


Subject(s)
Brain Neoplasms/diagnostic imaging , Cysts/diagnostic imaging , Brain/pathology , Brain/diagnostic imaging , Magnetic Resonance Spectroscopy , Tomography, X-Ray Computed , Neurocytoma , Hemangioblastoma , Ependymoma
3.
Journal of Biomedical Engineering ; (6): 1062-1071, 2021.
Article in Chinese | WPRIM | ID: wpr-921846

ABSTRACT

Glioma is the most common malignant brain tumor and classification of low grade glioma (LGG) and high grade glioma (HGG) is an important reference of making decisions on patient treatment options and prognosis. This work is largely done manually by pathologist based on an examination of whole slide image (WSI), which is arduous and heavily dependent on doctors' experience. In the World Health Organization (WHO) criteria, grade of glioma is closely related to hypercellularity, nuclear atypia and necrosis. Inspired by this, this paper designed and extracted cell density and atypia features to classify LGG and HGG. First, regions of interest (ROI) were located by analyzing cell density and global density features were extracted as well. Second, local density and atypia features were extracted in ROI. Third, balanced support vector machine (SVM) classifier was trained and tested using 10 selected features. The area under the curve (AUC) and accuracy (ACC) of 5-fold cross validation were 0.92 ± 0.01 and 0.82 ± 0.01 respectively. The results demonstrate that the proposed method of locating ROI is effective and the designed features of density and atypia can be used to predict glioma grade accurately, which can provide reliable basis for clinical diagnosis.


Subject(s)
Brain Neoplasms/diagnostic imaging , Glioma/diagnostic imaging , Humans , Magnetic Resonance Imaging , Neoplasm Grading , Support Vector Machine
4.
Article in Chinese | WPRIM | ID: wpr-921552

ABSTRACT

Objective To investigate the clinicopathological features and immunohistochemical phenotypes of brain metastatic carcinoma in Tibetan patients. Methods The clinical and pathological data of all patients with brain metastases from 2014 to 2020 in Tibet Autonomous Region People's Hospital were retrospectively analyzed,including 13 cases of brain metastatic carcinoma.All cases were diagnosed and classified by immunohistochemical staining. Results 13 cases(9 males and 4 females)of brain metastatic carcinoma,aged 26-62 years old,present with headache,dizziness,nausea and vomiting clinically.Four patients had a medical history of tumor,and among the 9 patients with no history of tumor,7 present space occupying lesions in both the brain and other organs.Imaging data could be found in 10 cases,including 4 cases of single lesion and 6 cases of multiple lesions.Primary tumors were identified in 11 cases(8 located in the lung,including 4 cases of adenocarcinoma,3 cases of small cell carcinoma,and 1 case of squamous cell carcinoma;1 case of urothelial carcinoma of the renal pelvis;1 case of thyroid papillary carcinoma;1 case of uterine choriocarcinoma),whereas the primary tumor was unknown for the other 2 cases(1 case of small cell carcinoma and 1 case of adenocarcinoma). Conclusions Brain metastatic carcinoma are more common among middle-aged and elderly people in Tibet.Most of the cases have no history of tumor,with the initial site at the brain metastatic lesions.The most common primary site is the lung,and the primary site of some cases is unknown.Multiple lesions are common in brain metastatic carcinoma,especially in the cerebral hemisphere.For older patients with multiple brain space occupying lesions,the possibility of brain metastatic carcinoma increases.


Subject(s)
Adult , Aged , Brain , Brain Neoplasms/diagnostic imaging , Carcinoma, Transitional Cell , Female , Humans , Male , Middle Aged , Retrospective Studies , Thyroid Neoplasms , Tibet , Urinary Bladder Neoplasms
5.
Article in Chinese | WPRIM | ID: wpr-921542

ABSTRACT

Cerebral metastases are the most common intracranial tumors in adults,with an increasing incidence in recent years.Radiomics can quantitatively analyze and process medical images to guide clinical practice.In recent years,CT and MRI-based radiomics has been gradually applied to the precise diagnosis and treatment of cerebral metastases,such as the precise detection and segmentation of tumors,the differential diagnosis with other cerebral tumors,the identification of primary tumors,the evaluation of treatment efficacy,and the prediction of prognosis.This article reviews the advances in radiomics of cerebral metastases.


Subject(s)
Brain Neoplasms/diagnostic imaging , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Prognosis , Supratentorial Neoplasms
6.
Article in Chinese | WPRIM | ID: wpr-921535

ABSTRACT

Objective To evaluate the application of two-dimensional magnetization-prepared true fast imaging with steady-state precession(2D-MP-TrueFISP)sequence in brain tumor enhancement.Methods In this study,60 cases of brain tumor patients who underwent enhanced magnetic resonance imaging of brain were scanned with 2D-MP-TrueFISP/two-dimensional spoiled gradient-recalled echo(2D-SPGR)before and after enhancement.The scores of lesions on the images of 2D-MP-TrueFISP/2D-SPGR were compared.At the same level of 2D-SPGE and 2D-MP-TrueFISP,the signal intensities(SIs)of lesions,white matter,and cerebrospinal fluid were measured before and after enhancement,and the contrast ratios(CRs)of lesions were calculated.The CRs before and after 2D-SPGR/2D-MP-TrueFISP enhancement and those between 2D-SPGR and 2D-MP-TrueFISP after enhancement were compared.Results The scores of lesions after 2D-MP-TrueFISP/2D-SPGR T1WI enhancement were 9.0(9.0,9.0)and 7.0(6.0,7.0),respectively,with significant difference(


Subject(s)
Brain , Brain Neoplasms/diagnostic imaging , Humans , Image Enhancement , Imaging, Three-Dimensional , Magnetic Resonance Imaging
7.
Article in Chinese | WPRIM | ID: wpr-878736

ABSTRACT

Intracranial intradural chondroma is a rare disorder,the imaging findings of which have been rarely reported.The current study reported a case of intracranial extra-cerebral chondroma and described the detailed CT and magnetic resonance imaging findings,which would provide valuable imaging evidence for the diagnosis of intracranial extra-cerebral chondroma.


Subject(s)
Brain Neoplasms/diagnostic imaging , Chondroma/diagnostic imaging , Humans , Magnetic Resonance Imaging , Tomography, X-Ray Computed
8.
Article in English | WPRIM | ID: wpr-880671

ABSTRACT

OBJECTIVES@#Glioma is the most common intracranial primary tumor in central nervous system. Glioma grading possesses important guiding significance for the selection of clinical treatment and follow-up plan, and the assessment of prognosis. This study aims to explore the feasibility of logistic regression model based on radiomics to predict glioma grading.@*METHODS@#Retrospective analysis was performed on 146 glioma patients with confirmed pathological diagnosis from January, 2012 to December, 2018. A total of 41 radiomics features were extracted from contrast-enhanced T@*RESULTS@#A total of 5 imaging features selected by LASSO were used to establish a logistic regression model for predicting glioma grading. The model showed good discrimination with AUC value of 0.919. Hosmer-Lemeshow test showed no significant difference between the calibration curve and the ideal curve (@*CONCLUSIONS@#The logistic regression model using radiomics exhibits a relatively high accuracy for predicting glioma grading, which may serve as a complementary tool for preoperative prediction of giloma grading.


Subject(s)
Brain Neoplasms/diagnostic imaging , Glioma/diagnostic imaging , Humans , Logistic Models , Magnetic Resonance Imaging , ROC Curve , Retrospective Studies
9.
Medicina (B.Aires) ; 80(5): 560-562, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1287211

ABSTRACT

Resumen El cáncer diferenciado de tiroides generalmente se acompaña de una supervivencia a largo plazo. Sin embargo, en algunos casos pueden desarrollarse metástasis a distancia y, entre ellas, las localizaciones cerebrales son de mal pronóstico. El objetivo de esta presentación es comunicar el caso clínico de una mujer de 65 años que consultó por diplopía en la mirada vertical que había aparecido un mes antes. La resonancia magnética mostró una gran masa a nivel del cóndilo occipital. Se realizó el diagnóstico de tumor cerebral primario, por lo que fue operada dos veces con resección tumoral incompleta. El estudio histopatológico confirmó una lesión metastásica de carcinoma de tiroides. Se realizó una tiroidectomía total con resección de un cáncer papilar de la variante folicular. Luego, fue tratada con éxito con pequeñas cantidades repetitivas de yodo radiactivo para una dosis total acumulada de 325 mCi 131I, con una supervivencia a largo plazo.


Abstract Differentiated thyroid cancer is generally accompanied by a long term survival. However,in some cases distant metastases can develop and among them, brain localizations are of poor prognosis. The aim of this presentation is to communicate the clinical case of a 65 year-old woman who consulted for diplopia in vertical gaze which had appeared one month earlier. MRI showed a big mass at the level of the occipital condyle. Diagnosis of primary brain tumor was made so she was operated twice with incomplete tumor resection. The pathological study was confirmatory of a metastatic lesion of thyroid carcinoma. A total thyroidectomy with resection of a papillary cancer of the follicular variant was performed. Then, she was successfully treated with small repetitive radioiodine amounts for a total accumulated dose of 325 mCi 131I, with a long-term survival.


Subject(s)
Humans , Female , Aged , Brain Neoplasms/radiotherapy , Thyroid Neoplasms/radiotherapy , Iodine Radioisotopes/therapeutic use , Brain Neoplasms/diagnostic imaging , Carcinoma, Papillary/radiotherapy
10.
Rev. bras. oftalmol ; 79(4): 276-277, July-Aug. 2020. graf
Article in English | LILACS | ID: biblio-1137971

ABSTRACT

Abstract Cerebellar astrocytoma (low-grade glioma) is the most frequent tumor of the Central Nervous System in pediatric age, corresponding to 10-20% of brain tumors, having its maximum incidence at 5 years. Brain tumors are the second cause of death at this age, behind leukemias. Its most frequent clinic is headache with vomiting which can worsen in the morning and awaken the patient at night. The most frequent ophthalmological clinic is papilledema and involvement of the cranial nerve VI. In our case we present an atypical presentation (cranial IV), in which a quick derivation favored a better prognosis.


Resumo O astrocitoma cerebelar (glioma de baixo grau) é o tumor mais frequente do Sistema Nervoso Central em idade pediátrica, correspondendo a 10-20% dos tumores cerebrais, tendo sua incidência máxima em 5 anos. Os tumores cerebrais são a segunda causa de morte nesta idade, atrás das leucemias. Sua clínica mais frequente é a cefaleia com vômitos que podem piorar pela manhã e despertar o paciente à noite. A clínica oftalmológica mais frequente é o papiledema e o envolvimento do nervo craniano VI. Em nosso caso apresentamos uma apresentação atípica (IV craniana), em que uma derivação rápida favoreceu um melhor prognóstico.


Subject(s)
Humans , Child, Preschool , Astrocytoma/diagnostic imaging , Brain Neoplasms/diagnostic imaging , Papilledema/physiopathology , Glioma/diagnostic imaging , Headache/physiopathology , Tomography, X-Ray Computed/methods
11.
Rev. chil. radiol ; 26(1): 12-16, mar. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1115520

ABSTRACT

Resumen: Los oligodendrogliomas anaplásicos son gliomas infiltrantes grado III de la organización mundial de la salud (OMS). Son tumores poco frecuentes y representan el 5-10% de todas las neoplasias intracraneales primarias. Su incidencia es de 0.3 por 100.000 habitantes por año en Estados Unidos. Con frecuencia se presentan en adultos entre los 40-60 años de edad. Los síntomas principales pueden ser déficit motor, déficit cognitivos y síntomas de aumento de la presión intracraneal. Su comportamiento en resonancia magnética muestra un aspecto heterogéneo con necrosis, degeneración quística y hemorragia intratumoral. Las presentaciones quísticas extensas son poco frecuentes. Reportamos el caso de un oligodendroglioma anaplásico de aspecto predominantemente quístico en una mujer joven.


Abstract: Anaplastic oligodendrogliomas are grade III infiltrating gliomas of the World Health Organization (WHO). They are rare tumors and represent 5-10% of all primary intracranial neoplasms. Its incidence is 0.3 per 100.000 inhabitants per year in the United States. They often occur in adults between 40-60 years of age. The main symptoms may be motor deficit, cognitive deficits and symptoms of increased intracranial pressure. Its behavior in MRI shows a heterogeneous appearance with necrosis, cystic degeneration and intratumoral hemorrhagic. Extensive cystic presentations are rare. We report the case of an anaplastic oligodendroglioma of predominantly cystic appearance in a young woman.


Subject(s)
Humans , Female , Adult , Oligodendroglioma/diagnostic imaging , Brain Neoplasms/diagnostic imaging , Oligodendroglioma/pathology , Brain Neoplasms/pathology , Immunohistochemistry , Magnetic Resonance Imaging , Contrast Media
12.
Arq. neuropsiquiatr ; 78(2): 112-120, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088992

ABSTRACT

Abstract Background: Central nervous system (CNS) gliosarcoma (GSM) is a rare primary neoplasm characterized by the presence of glial and sarcomatous components. Objective: In this report, we describe the clinical and neuroimaging aspects of three cases of GSM and correlate these aspects with pathological findings. We also provide a brief review of relevant literature. Methods: Three patients were evaluated with magnetic resonance imaging (MRI), and biopsies confirmed the diagnosis of primary GSM, without previous radiotherapy. Results: The analysis of conventional sequences (T1, T1 after contrast injection, T2, Fluid attenuation inversion recovery, SWI and DWI/ADC map) and advanced (proton 1H MR spectroscopy and perfusion) revealed an irregular, necrotic aspect of the lesion, peritumoral edema/infiltration and isointensity of the solid component on a T2-weighted image. These features were associated with irregular and peripheral contrast enhancement, lipid and lactate peaks, increased choline and creatine levels in proton spectroscopy, increased relative cerebral blood volume (rCBV) in perfusion, multifocality and drop metastasis in one of the cases. Conclusion: These findings are discussed in relation to the general characteristics of GSM reported in the literature.


Resumo Introdução: O gliossarcoma (GSM) do sistema nervoso central (SNC) é uma neoplasia primária rara, caracterizada pela presença de componentes gliais e sarcomatosos. Objetivo: Nosso objetivo é descrever os aspectos clínicos e de neuroimagem de três casos com este diagnóstico e correlacioná-los com os achados patológicos. Também foi realizada uma breve revisão da literatura relevante. Métodos: Três pacientes foram avaliados por ressonância magnética (RM), e biópsias confirmaram o diagnóstico de GSM primário, sem radioterapia prévia. Resultados: Foram analisadas as sequências convencionais (T1, T1 após injeção de contraste, T2, FLAIR-fluid attenuation inversion recovery, SWI, DWI/mapa ADC) e as sequências avançadas (espectroscopia de prótons 1H e perfusão), observando-se aspecto necrótico e irregular da lesão, edema/infiltração peritumoral, isointensidade do componente sólido em T2, associada a realce irregular e periférico pelo meio de contraste, pico de lípides e de lactato e aumento dos níveis de colina e creatina na espectroscopia de prótons, aumento do volume sanguíneo cerebral relativo (rCBV) na perfusão, multifocalidade e "drop" mestástase em um dos casos. Conclusão: O presente estudo descreve características do GSM, discutindo as informações na literatura científica, ilustrando algumas particularidades desses tumores.


Subject(s)
Humans , Brain Neoplasms/diagnostic imaging , Gliosarcoma/diagnostic imaging , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy
13.
Einstein (Säo Paulo) ; 18: eAO4948, 2020. tab, graf
Article in English | LILACS | ID: biblio-1090075

ABSTRACT

ABSTRACT Objective To develop a computational algorithm applied to magnetic resonance imaging for automatic segmentation of brain tumors. Methods A total of 130 magnetic resonance images were used in the T1c, T2 and FSPRG T1C sequences and in the axial, sagittal and coronal planes of patients with brain cancer. The algorithms employed contrast correction, histogram normalization and binarization techniques to disconnect adjacent structures from the brain and enhance the region of interest. Automatic segmentation was performed through detection by coordinates and arithmetic mean of the area. Morphological operators were used to eliminate undesirable elements and reconstruct the shape and texture of the tumor. The results were compared with manual segmentations by two radiologists to determine the efficacy of the algorithms implemented. Results The correlated correspondence between the segmentation obtained and the gold standard was 89.23%. Conclusion It is possible to locate and define the tumor region automatically with no the need for user interaction, based on two innovative methods to detect brain extreme sites and exclude non-tumor tissues on magnetic resonance images.


RESUMO Objetivo Desenvolver um algoritmo computacional aplicado a imagens de ressonância magnética, para segmentação automática de tumores cerebrais. Métodos Foram utilizadas 130 imagens de ressonância magnética nas sequências T1c, T2 e FSPRG T1c e nos planos axial, sagital e coronal de pacientes acometidos com câncer cerebral. Os algoritmos empregaram técnicas de correção de contraste, normalização de histograma e binarização, para desconectar estruturas adjacentes do cérebro e realçar a região de interesse. A segmentação automática foi realizada por meio da detecção por coordenadas e por média aritmética da área. Operadores morfológicos foram utilizados para eliminar elementos indesejáveis e reconstruir a forma e a textura do tumor. Os resultados foram comparados com as segmentações manuais de dois médicos radiologistas, para determinar a eficácia dos algoritmos implementados. Resultados Os acertos foram de 89,23% na correspondência entre a segmentação obtida e o padrão-ouro. Conclusão É possível localizar e delimitar a região tumoral de forma automática, sem necessidade de interação com o usuário baseado em dois métodos inovadores de detecção dos extremos do cérebro e de exclusão dos tecidos não tumorais em imagens de ressonância magnética.


Subject(s)
Humans , Algorithms , Image Processing, Computer-Assisted/methods , Brain Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Reference Standards , Brain , Reproducibility of Results , Diagnosis, Computer-Assisted/methods
14.
Arq. neuropsiquiatr ; 77(11): 797-805, Nov. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055187

ABSTRACT

ABSTRACT Drug-resistant epilepsy associated with central nervous system tumors is generally caused by low grade gliomas. This group of tumors is usually found in brain eloquent areas, such as the insular lobe, rolandic cortex and supplementary motor area and, historically, possess a greater risk of postoperative deficits. Objective: The aim of this investigation was to present our surgical experience on patients with drug-resistant epilepsy caused by gliomas in eloquent areas. We retrospectively investigated variables that impact seizure control, such as tumor location, extent of resection, invasion into the lenticulostriate arteries in the patient, especially those with insular gliomas. Methods: Out of 67 patients with eloquent area brain tumors operated on in our service between 2007 and 2016, 14 patients had symptoms of drug-resistant epilepsy. Volumetric analysis, extent of resection (EOR), type of approach and mapping, among other factors were correlated with the 12-month postoperative seizure outcome. Results: Univariate analysis showed that the factors showing statistical relevance with seizure control were preoperative volume (p = 0.005), EOR (p = 0.028) and postoperative volume (p = 0.030). Conclusion: There was a statistically significant association between the EOR and the Engel score for epilepsy control: an EOR < 70 was associated with Engel II, III, IV and an EOR > 90 was associated with Engel I. Eloquent area gliomas can safely be resected when surgeons use not only microsurgical anatomy concepts but also brain mapping.


RESUMO Epilepsia refratária secundária a tumores cerebrais são geralmente causadas por gliomas de baixo grau. Esse grupo de tumor é frequentemente localizado em áreas eloquentes do cérebro como na insula, córtex rolândico e área motora suplementar; e sua ressecção apresenta alto risco de déficits neurológicos no pós operatório. Objetivo: O objetivo do estudo consiste em apresentar nossa experiência no tratamento cirúrgico de pacientes com epilepsia refratária secundário a gliomas em áreas eloquentes. Métodos: O estudo consiste em investigação retrospectiva de variáveis que interferem no controle de crises, tais como localização do tumor, grau de ressecção, invasão tumoral de artérias lenticulo estriadas, principalmente em gliomas insulares. Dentre 67 pacientes portadores de gliomas em área eloquente operados no período de 2007 a 2016, 14 doentes apresentavam epilepsia refrataria associada. Análise volumétrica do tumor, grau de ressecção, acesso cirúrgico, bem como o uso de mapeamento cortical intraoperatório foram correlacionados com desfecho de controle de crises epilepticas em 12 meses. Resultados: Em análise univariada os fatores relacionados com controle de crises em 12 meses foram volume tumoral pré operatório (p = 0,005), grau de ressecção (p = 0,028) e volume tumoral pós operatório. Conclusão: O grau de ressecção apresentou significância estatística em relação ao controle de crises conforme escala de Engel. Ressecções menores que 70% apresentaram correlação com Engel II, III e IV; enquanto ressecções maiores que 90% apresentaram correção positiva com Engel I. Gliomas em áreas eloquentes podem ser ressecados de forma segura desde que seja realizada por equipe experiente com conhecimento acurado da anatomia microcirúrgica e emprego de mapeamento cortical intraoperatório.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Brain Neoplasms/surgery , Brain Neoplasms/complications , Brain Neoplasms/etiology , Drug Resistant Epilepsy/surgery , Glioma/surgery , Glioma/complications , Postoperative Period , Seizures/surgery , Seizures/etiology , Brain Mapping , Brain Neoplasms/mortality , Brain Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Kaplan-Meier Estimate , Glioma/mortality , Glioma/diagnostic imaging
15.
Rev. méd. Chile ; 147(11): 1487-1490, nov. 2019. graf
Article in Spanish | LILACS | ID: biblio-1094178

ABSTRACT

The 2016 WHO Classification of Tumours of the Central Nervous System incorporates a new diagnostic entity: the mutant diffuse midline glioma H3K27, a tumor with a characteristic location and special molecular biology. We report the case of a 51-year-old male patient with progressive diplopia. The imaging study showed a mesencephalic tumor; the stereotacic biopsy disclosed an Anaplastic Astrocytoma Isocitrate dehydrogenase (IDH) wild type. The molecular study concludes H3K27 mutation. The patient was treated with radiotherapy with concurrent and adjuvant chemotherapy (temozolomide) with partial recovery of the diplopia.


Subject(s)
Humans , Male , Middle Aged , Brain Neoplasms/genetics , Histones/genetics , Glioma/genetics , Mutation/genetics , Brain Neoplasms/pathology , Brain Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Biomarkers, Tumor , Genetic Markers , Neuroimaging , Glioma/pathology , Glioma/diagnostic imaging
16.
Rev. otorrinolaringol. cir. cabeza cuello ; 79(2): 207-212, jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1014439

ABSTRACT

RESUMEN El lipoma intraóseo es un tumor mesenquimatoso poco frecuente que se presenta principalmente en el esqueleto apendicular. La localización dentro del cráneo, es aún más rara, y hasta la fecha solo se han descrito 6 casos en la literatura de lipomas intraóseos que comprometen la región esfenoclival. Por lo general, no presenta ningún síntoma y es un hallazgo incidental en el estudio de imágenes. Presentamos el caso de un paciente de 22 años de edad que consulta por obstrucción nasal y rinorrea mucosa de tres semanas de evolución. La tomografía computarizada y resonancia nuclear magnética evidenciaron una lesión en la región esfenoclival con características sugerentes de lipoma intraóseo. No se realiza estudio histopatológico. Con respecto al manejo, se decide hacer seguimiento radiológico. Se realizó una segunda resonancia magnética 4 meses después, sin cambios significativos.


ABSTRACT Intraosseous lipoma are a rare mesenchymal tumor that occurs primarily in the appendicular skeleton. Skull presentation is a rare finding, and only 6 cases have been described in literature so far of lipomas that compromise the sphenoclival region. In general, they are asymptomatic and occur as incidental findings in imaging studies. We present the case of a 22-year-old patient who consulted for nasal obstruction and mucous rhinorrhea of three weeks of evolution. Computed tomography and magnetic resonance imaging showed a lesion in the sphenoclival region suggestive of intraosseous lipoma. Histopathological study was not performed. Regarding management, radiological follow-up was decided. A second MRI was taken 4 months later, with no significant changes.


Subject(s)
Humans , Male , Adult , Young Adult , Brain Neoplasms/diagnostic imaging , Skull Base/diagnostic imaging , Lipoma/diagnostic imaging , Paranasal Sinuses/diagnostic imaging , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Diagnosis, Differential
17.
Rev. Assoc. Med. Bras. (1992) ; 65(3): 424-433, Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003031

ABSTRACT

SUMMARY OBJECTIVE: Extracranial metastases of glioblastoma multiforme (GBM) are rare due to the short survival experienced by the patients. Therefore, the natural history of GBM metastases remains elusive. The identification of clinical factors promoting GBM metastases may help elucidate the mechanisms of tumor cell invasion in the brain. The aims of this study were to perform a meta-analysis evaluating the survival, characteristics, prognostic factors, and predictors of treatment outcome in patients with metastatic GBM and describe a case of metastatic extracranial GBM. METHODS: We report the case of a patient diagnosed with GBM metastatic to the lungs and the results of a meta-analysis of 114 other cases of metastatic GBM identified through a MEDLINE and BIREME search. RESULTS: The mean age of the patients was 38.2±16.1 years and 70.4% were male. The time elapsed between the identification of the metastasis and death was significantly increased in patients undergoing surgery (p=0.019), whereas the time from the diagnosis of the primary tumor to death was significantly increased in patients receiving radiation therapy (p=0.050). The time elapsed from metastasis to death and diagnosis to death was significantly longer in patients receiving chemotherapy (p<0.001 and p=0.027, respectively). The liver was the metastatic site associated with the shortest time elapsed from diagnosis to death (p=0.024). CONCLUSIONS: In GBM, surgical resection is important in reducing the risk of metastasis, and chemotherapy and radiation therapy help to prolong survival in metastatic GBM. Metastases to the liver are associated with shorter survival compared with metastases to other sites.


RESUMO OBJETIVO: Metástases extracranianas do glioblastoma multiforme (GBM) são raras devido à baixa sobrevida dos pacientes. Portanto, a história natural das metástases do GBM permanece incerta. A identificação de fatores clínicos que promovem metástases no GBM pode ajudar a elucidar os mecanismos de invasão das células tumorais no cérebro. O objetivo deste estudo foi realizar uma meta-análise avaliando a sobrevida, características, fatores prognósticos e preditores de desfechos do tratamento em pacientes com GBM metastático e descrever um caso de GBM extracraniano metastático. MÉTODOS: Relatamos o caso de uma paciente diagnosticada com GBM metastático para os pulmões e os resultados de uma meta-análise de 114 outros casos de GBM metastático identificados por meio de uma pesquisa no Medline e Bireme. RESULTADOS: A média de idade dos pacientes foi de 38,2±16,1 anos e 70,4% eram do sexo masculino. O tempo decorrido entre a identificação da metástase e o óbito foi significativamente maior em pacientes submetidos à cirurgia (p = 0,019), enquanto que o tempo do diagnóstico do tumor primário até o óbito aumentou significativamente em pacientes submetidos à radioterapia (p = 0,050). O tempo decorrido da metástase até o óbito e do diagnóstico até o óbito foi significativamente maior nos pacientes que receberam quimioterapia (p < 0,001 e p = 0,027, respectivamente). O fígado foi o local metastático associado ao menor tempo decorrido do diagnóstico até a morte (p = 0,024). CONCLUSÕES: No GBM, a ressecção cirúrgica é importante para redução do risco de metástase, e a quimioterapia e a radioterapia ajudam a prolongar a sobrevida no GBM metastático. Metástases para o fígado estão associadas a uma sobrevida mais curta quando comparadas a metástases para outros locais.


Subject(s)
Humans , Female , Adult , Brain Neoplasms/pathology , Glioblastoma/secondary , Lung Neoplasms/secondary , Time Factors , Brain Neoplasms/mortality , Brain Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Glioblastoma/mortality , Glioblastoma/diagnostic imaging , Statistics, Nonparametric , Lung Neoplasms/mortality , Lung Neoplasms/diagnostic imaging
18.
Rev. Assoc. Med. Bras. (1992) ; 65(2): 136-140, Feb. 2019. graf
Article in English | LILACS | ID: biblio-990325

ABSTRACT

SUMMARY We describe the case of a female patient, 52 years old, with dizziness and left motor incoordination for 2 weeks. Brain MRI magnetic resonance imaging) revealed a hyperintense lesion on T2-weighted images, without restricted diffusion, in the left middle cerebellar peduncle. Spectroscopy demonstrated peak of lipids and perfusion did not show any elevation in relative cerebral blood volume (rCBV). The patient underwent an open biopsy and resection, and the diagnosis of diffuse large B-cell lymphoma (DLBCL) was established. The patient received intravenous dexamethasone with symptoms remission, followed by four cycles of methotrexate plus cytarabine. After 3 months, the patient returned with decreased consciences level and a new MRI revealed a right superior frontal gyrus lesion with features suggesting a lymphomatous lesion. The patient died five days after her relapse.


RESUMO Descrevemos o caso de uma paciente do sexo feminino, de 52 anos, apresentando história de tontura e perda da coordenação motora do lado esquerdo há duas semanas. A RM (ressonância magnética) de crânio revelou uma lesão hiperintensa nas imagens ponderadas em T2, sem restrição à difusão, localizada no pedúnculo cerebelar médio esquerdo. A espectroscopia demonstrou pico de lipídeos, sem elevação do volume sanguíneo cerebral relativo (rCBV) à perfusão. A paciente foi submetida à biópsia a céu aberto, estabelecendo o diagnóstico de linfoma difuso de grandes células B (DLBCL). Houve remissão dos sintomas após o início do tratamento com dexametasona endovenosa, seguida de quatro ciclos de metotrexato associado à citarabina. Após três meses, a paciente retornou apresentando rebaixamento do nível de consciência, e a RM de crânio revelou uma nova lesão de origem linfomatosa no giro frontal superior direito. A paciente faleceu após cinco dias.


Subject(s)
Humans , Female , Brain Neoplasms/diagnostic imaging , Lymphoma, Large B-Cell, Diffuse/diagnostic imaging , Brain Neoplasms/drug therapy , Magnetic Resonance Imaging , Lymphoma, Large B-Cell, Diffuse/drug therapy , Fatal Outcome , Immunocompetence , Middle Aged , Neoplasm Recurrence, Local
19.
Arch. endocrinol. metab. (Online) ; 62(6): 648-654, Dec. 2018. graf
Article in English | LILACS | ID: biblio-983804

ABSTRACT

SUMMARY Chordoid glioma (CG) is considered a slow growing glial neoplasm. We report two new cases with endocrinological presentation, management and outcome. Case reports: 1) An 18 year-old female patient was admitted due to headaches, nausea and vomiting and visual abnormalities. She was in amenorrhea. A brain magnetic resonance imaging (MRI) demonstrated a 35 mm-diameter sellar and suprasellar mass. An emergency ventricular peritoneal valve was placed due to obstructive hydrocephalus. Transcraneal surgery was performed. The patient developed central hypothyroidism, adrenal insufficiency and transient diabetes insipidus; she never recovered spontaneous menstrual cycles. Histopathologic study showed cells in cords, inside a mucinous stroma, positive for glial fibrillary acidic protein (GFAP). Due to residual tumor gamma knife radiosurgery was performed. Three years after surgery, the patient is lucid, with hypopituitarism under replacement. 2) A 46 year-old woman complained about a three year-history of amenorrhea, galactorrhea and headache. An MRI showed a solid-cystic sellar mass 40 mm-diameter that extended to the suprasellar cistern. She had hypogonatropic hypogonadism and mild hyperprolactinemia. The tumor mass was removed via nasal endoscopic approach. Histopathological study reported cellular proliferation of glial lineage positive for GFAP. The patient evolved with central hypothyroidism and diabetes insipidus. She was re-operated for fistula and again under the diagnosis of extradural abscess. She evolved with cardiorespiratory descompensation and death, suspected to be due to a thromboembolism. In conclusion, the first case confirms that best treatment for CG is surgery considering radiotherapy as an adjuvant therapy. The other case, on the contrary, illustrates the potentially fatal evolution due to surgical complications.


Subject(s)
Humans , Female , Adolescent , Middle Aged , Brain Neoplasms/pathology , Third Ventricle/pathology , Glioma/pathology , Sella Turcica , Biopsy , Brain Neoplasms/surgery , Brain Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Treatment Outcome , Fatal Outcome , Third Ventricle/surgery , Third Ventricle/diagnostic imaging , Glioma/surgery , Glioma/diagnostic imaging
20.
Säo Paulo med. j ; 136(5): 492-496, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-979372

ABSTRACT

ABSTRACT CONTEXT: Central nervous system (CNS) infectious diseases have high prevalence in developing countries and their proper diagnosis and treatment are very important for public health planning. Cryptococcus neoformans is a fungus that may cause several CNS manifestations, especially in immunocompromised patients. Cryptococcal meningitis is the most common type of involvement. Mass-effect lesions are uncommon: they are described as cryptococcomas and their prevalence is even lower among immunocompetent patients. The aim here was to report an extremely rare case of cryptococcoma causing a mass effect and mimicking a brain tumor in an immunocompetent patient. The literature on CNS cryptococcal infections was reviewed with emphasis on cryptococcomas. Clinical, surgical and radiological data on a female patient with this rare presentation of cryptococcoma mimicking a brain tumor are described. Case Report: A 54-year-old female patient presented to the emergency department with a rapid-onset progressive history of confusion and completely dependency for basic activities. Neuroimaging showed a left occipital lesion and neurosurgical treatment was proposed. From histopathological evaluation, a diagnosis of cryptococcoma was established. She received clinical support with antifungals, but despite optimal clinical treatment, her condition evolved to death. CONCLUSIONS: Cryptococcal infections have several forms of presentation and, in immunocompetent patients, their manifestation may be even more different. Cryptococcoma is an extremely rare presentation in which proper surgical and clinical treatment should be instituted as quickly as possible, but even so, there is a high mortality rate.


Subject(s)
Humans , Female , Middle Aged , Central Nervous System Fungal Infections/diagnostic imaging , Cryptococcosis/diagnostic imaging , Cryptococcus neoformans/isolation & purification , Immunocompetence , Brain Neoplasms/pathology , Brain Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Immunocompromised Host , Fatal Outcome , Central Nervous System Fungal Infections/pathology , Cryptococcosis/pathology , Rare Diseases/pathology , Rare Diseases/diagnostic imaging , Diagnosis, Differential
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